The comparison of two doses of intranasal midazolam sedation in a paediatric dental emergency clinic

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The aim of the study was to compare two doses of intranasal midazolam (INM) 0.3
mg/kg and 0.5 mg/kg in terms of effectiveness and recovery time. Design:-This study was a Randomized Controlled Trial (RCT) and Triple blinded study. Sample and methods A sample of one hundred and eighteen children aged from 4-6 years old were randomly assigned for Intranasal sedation (INS) to either the 0.3 mg/kg group or the 0.5 mg/kg group. Children were taken in fasting and non-fasting conditions. The children were monitored using a pulse-oximeter, the sedation was assessed using Wilson sedation scale and the anxiety and behaviour scales were rated by Venham’s scale throughout the treatment. The facial image Scale (FIS) was also used to assess anxiety and mood of children before and after treatment. Results The mean BMI of children was found to be from 14-16. Intranasal sedation with both 0.3 mg/kg and 0.5 mg/kg midazolam was completed in 100% of the children. The pulse rates were within normal limit but statistically lower in the 0.5 mg/kg group. Oxygen saturation was above 98% in all except for one child who desaturated to 90%. Thirty five percent found this route acceptable in this study; Nine percent had burning sensation from midazolam. The state anxiety between the two groups of 0.3 mg/kg and 0.5 mg/kg were insignificant using Venham’s scale. However, behaviour scores showed statistical significant results of p value (0.03) and (0.04) in the behaviour during LA and behaviour during extractions respectively. The facial images scale (FIS) ratings chosen by the children before and after sedation was insignificant to the anxiety and behaviour ratings. The FIS revealed that 66% chose a happy face at the end of treatment. Fifty percent of the children in the study chose the same image before and after sedation. There were no adverse events encountered during the procedure. Conclusion INS with midazolam using the 0.3 mg/kg or 0.5 mg/kg doses resulted in safe and effective sedation. The 0.5 mg/kg proved to be more effective than the 0.3 mg/kg in providing better behaviour and decreasing anxiety when compared with the 0.3 mg/kg dose. The 0.5 mg/kg dose was found to be safe and the recovery time was slightly more than the 0.3 mg/kg but the difference was not clinically significant.